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Free Content Inverted Papilloma: A Review and What's New

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Although inverted papilloma (IPap) is a rare neoplasm, it is of considerable interest as it can be locally aggressive, has a high rate of recurrence, and is associated with malignancy. The name “inverted” refers to the histology of the lesion as there is invagination of hyperplastic epithelium into the underlying stroma. The pathogenesis of IPap is unclear and associations with inflammation, noxious agents, and human papilloma virus (HPV) have been proposed. Synchronous or metachronous malignancy is reported in 5%‐15% of cases, with squamous cell carcinoma being the most common associated malignancy. Imaging plays an important role in differentiating IPap from other lesions (polyps), detecting coexistent malignancy, guiding the surgeon for the appropriate surgical approach, and detecting recurrences. It is important to identify the point of attachment of the lesion to the nasal cavity wall or sinus wall, as incomplete resection can result in recurrence. The characteristic MR appearance of IPap is a convoluted, cerebriform pattern that correlates with the lesion's histology. The treatment of choice is complete surgical resection and the approach used depends upon the location of tumor attachment and extent of the lesion. Endonasal endoscopic, limited external, radical external, and combined endoscopic-external approaches may be used. Long-term follow-up is recommended to detect late recurrences and metachronous multifocal disease.

Learning Objective: Understand the epidemiology of inverted papilloma and research with respect to HPV, the role of imaging and distinctive imaging features of inverted papilloma, and current treatment approaches for inverted papilloma.
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Keywords: EBV = Epstein Barr virus; HPV = human papilloma virus; IPap = inverted papilloma; SCCa = squamous cell carcinoma

Document Type: Research Article

Publication date: May 1, 2015

More about this publication?
  • Neurographics is the peer-reviewed, bimonthly educational journal of the American Society of Neuroradiology. The journal comprises articles selected from material presented at the ASNR Annual Meeting. Neurographics also publishes other high-quality submissions that are primarily educational and have a high emphasis on a pictorial approach. Neurographics offers CME credit for reading review articles and completing quiz-based self-assessment activities.

    Visit to view all available CME courses.

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